Institute of Disaster Mitigation for Urban Cultural Heritage, Ritsumeikan University

UNESCO Chair Programme on Cultural Heritage and Risk Management,International Training Course (ITC)on Disaster Risk Management of Cultural Heritage 2024

APPLICATION FORM
Please complete this form in full, by computer.

1.

APPLICANTFirst Name

Family Name

Middle Name
Date of Birth: D/M/YAge
PhotographNationality

Place of BirthExpertise
Gender( ) Cultural Heritage Field( ) Disaster Management
or Related Field
In which region is your country located? (please refer to http://www.mofa.go.jp/region/index.html)
Please indicate the main disaster risks in your area. (ex; earthquake and fire)

Professional Status:( ) University Professor/Lecturer( ) International Organization ( ) National authority ( ) Local authority( ) Professional institution of national relevance ( ) Urban Planner ( ) Doctoral Scholars/Students( ) Private firm/Individual Professional ( ) NPO/NGOs ( ) Others ()Affiliation (Name of University, Authority, Institute or Company etc):
Present Position:
Web Site: (If available)
Office Address
Office Phone No. (+ Country Code)Country:

Postal Code:Country:

Office Fax No.

Home Address
Home Phone No. (+ Country Code)Postal Code:Home Fax No.

Mobile (Cell) Phone No.

Which is a preferred contact address?
( ) Office ( ) Home
Email Address
Preferred:
Alternatives:

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EDUCATIONAL BACKGROUND
Latest Academic Qualifications
Full Name of Institutionand Country

Duration(D/M/Y-D/M/Y)

College, Department

Degree Obtained

Relevant Professional Courses
Duration (D/M/YD/M/Y)

Full Name of Course, Institution and Country

Certification Obtained

2. ENGLISH LANGUAGE ABILITY
Please rate your language proficiency from Excellent to Poor
Excellent
GoodFairPoor

SpokenUnderstandingWritten

3. PROFESSIONAL ACTIVITIESDescribe your current responsibilities and professional activities

Relevant Previous Activities

Dates (D/M/Y-D/M/Y)

Responsibilities

2Professional Experience( ) Less than 2 years experience in the cultural heritage conservation or disaster risk management field( ) 3 to 4 years experience in the cultural heritage conservation or disaster risk management field( ) 5-15 years experience in the cultural heritage conservation or disaster risk management field( ) More than 15 years experience in the cultural heritage conservation or disaster risk management field

4. The Cultural Heritage Site/Museum for which a Disaster Risk Management Plan
will be formulated:
Name of the site/museum:Is this a World Heritage Site?
( ) Yes ( ) No
If not, what is the status of the site/museum?
( ) Tentative List of World Heritage ( ) Nationally Protected Site ( ) Locally Protected Site( ) Unprotected Site
What is the type of cultural heritage selected by you?
( ) Single Monument ( ) Group of Buildings or Ensemble ( ) Historic City or Urban Area
( ) Archaeological Site ( ) Cultural Landscape ( ) Museum( ) Any other (please specify)
Location of the site/museumLatitude / Longitude ()* This information is available out through Google map by pointing the cursor on the designated location.
Right click the location, and go to “Detail of the location” first. Once a green arrow appears, point the arrow with thecursor to find out the information.

Photo of the site/museum

5. Reason for Selecting the above Cultural Heritage Site/Museum:3

Institute of Disaster Mitigation for Urban Cultural Heritage, Ritsumeikan University

UNESCO Chair Programme on Cultural Heritage and Risk Management,International Training Course (ITC)on Disaster Risk Management of Cultural Heritage 2024

Short paper(Around 1000 words)(Please write here)5Institute of Disaster Mitigation for Urban Cultural Heritage, Ritsumeikan University

UNESCO Chair Programme on Cultural Heritage and Risk Management,International Training Course (ITC)on Disaster Risk Management of Cultural Heritage 2024

QUESTIONNAIRE
As part of commitment to provide high quality training course, we would appreciate your honest and constructive
reactions to this training course. All comments will, of course, be treated in the strictest confidence.

Q1. Where did you know this training course?
□A
□B
□C
□D□E
□F
□G□H

From R-DMUCH or Ritsumeikan University website
From UNESCO website
From ICCROM website
From ICOMOS/ICORP website
From ICOM website
From PreventionWeb website
From my colleagues or friends
Other→ Please describe briefly.

Q2. What expectation do you have during this training course?
□A
□B
□C

I want to know techniques and policies of Disaster Risk Management for Cultural Heritage in case ofJapan.
I want to share the knowledge and experience with the other participants and resource person, and to makeinternational network.
Other→ Please describe brieﬂy.

Q3. What plan do you have after this training course?
□A
□B
□C
□D

I will share the knowledge and experience with my colleagues.
I will organize a training based on the experience and knowledge from the training in Japan.
I will propose the Cultural Heritage Risk Management plan.
Other→ Please describe brieﬂy.

Q4. Do you have any plan to apply financial support from sources such as
governmental institutions or any funding agencies?
□A
□B
□C

My affiliated institution or a funding agency will support me.
I will apply to some funding agencies.
I don’t have any funding source.

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